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HomeMy WebLinkAboutBLDP&G-21-006802 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 5/24/21 PERMIT# BLDP-21-006802 JOBSITE ADDRESS 4 WEST WOODS VILLAGE OWNER'S NAME JEFFERSON NORMA TR P OWNER ADDRESS NORMA JEFFERSON TRUST 4 WEST WOODS YARMOUTH PORT,MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: D RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTE DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER 1 WATER PIPING OTHER OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES❑ NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER TYPE OF INDEMNITY❑ BOND❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Stephen Winslow LICENSE 1Q298 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME ISTEPHEN A WINSLOW I ADDRESS 8 REARDON CIR CITY IS YARMOUTH I STATE MA ZIP 026641207 TEL FAX I 1 CELL I I EMAIL inspections@efwinslow.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE PERMIT FEES S PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK it - , r,,, tf. CITY I yarmouth 1 MA DATE 05/17/21 PERMIT # JOBSITE ADDRESS E.4 westwoods, yarmouthport OWNER'S NAME jefferson P OWNER ADDRESS r TEL 508.362.2653 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL [1 RESIDENTIAL ID PRINT CLEARLY NEW: I i RENOVATION: : REPLACEMENT: i PLANS SUBMITTED: YES i 1 NO FIXTURES Z FLOOR-- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB nnn=n=-=nrmunr-asr----m CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM iiiiiiIIIM iiim iiiii I , DEDICATED GAS/OIL/SAND SYSTEM IIIIIIMMI 111111,111111.11MIIIIMIII01.1111111111111111 DEDICATED GREASE SYSTEM maim aw---misimmimmilialmmonommem DEDICATED GRAY WATER SYSTEM IIIIIIM NNE IMIIIIIIIIIIIIMMONIMIIIIIIIIMM DEDICATED WATER RECYCLE SYSTEM 1 DISHWASHE1Mi -11- 1 r -71 i MI R f DRINKING FOUNTAIN FOOD DISPOSER . L MI II INTERCEPTOR (INTERIOR) IIIIIIMTFMIIIIIIIIIIIMIMITMIRIIIIIIIIIIMIIIIIII 11111111111 KITCHEN SINK liei~fMIIIIIMIIIIIIIIIIIIIItM NM 11.IIIIIMIEIMIIW'illIllMM1 LAvAT(DRY MINIIIIIIIMIIIIIIIIMM=II 111111iiiiiiiMiliiit 11111M1111.1— •• �I ill _ SHOWER STALL 1111111111011111111111111111111111111.11110 11111111M01111111Maiiii111.NMI SERVICE / MOP SINK IIIIIENIIIIIIIIIIIIIIIIMTMIIIIIMIIIMIIIIIME N TOILET _ �1 URINAL '_ WASHING MACHINE CONNECTIONM.11111.111110., _ _ , ra—M011,11111111--11M WATER HEATER ALL TYPES I '. WATER PIPING I OTHER I .. .. . mm ._. MIII I I , ' w\o 551256 $40 00 ". 1-I . NINIII INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES l , I NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY '? v OTHER TYPE OF INDEMNITY fl BOND . OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 1.w.. AGENT El SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true r to to the b t of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in com lia with II ertine prm(isio of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. - r ,.k.� PLUMBERS NAME , STEPHEN W ,..- _. ,.]LICENSE EPEN WINSLOW _ # 112298 _ SIGNATURE MP _+ JP 1 CORPORATION ;:: #[ 3281C .,_,... IPARTNERSHIP # LLC I#, _..,w .. .�.._ COMPANY NAME E.F. WINSLOW PLUMBING & HEATING ADDRESS 8 R,EARDON CIRCLE CITY SOUTH YARMOUTH STATE MA1 ZIP 02664 TEL 508-394-7778 FAX 508-394-8256 CELL I N/A EMAIL 1INSPECONS@EFWINSLOW COM MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE May 24,2021 PERMIT# BLDP-21-006802 t--t= JOBSITE ADDRESS 4 WEST WOODS VILLAGE OWNER'S NAME JEFFERSON NORMA TR G OWNER ADDRESS NORMA JEFFERSON TRUST 4 WEST WOODS YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL ❑ PRINT CLEARLY NEW: 0 RENOVATION:D REPLACEMENT:© PLANS SUBMITTED: YES 0 NO ❑ FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT_ TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 1 OTHER OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES © NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER OF INDEMNITY❑ BOND ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Stephen Winslow LICENSE# 12298 SIGNATURE MP© MGF 0 JP 0 JGF 0 LPGI ❑ CORPORATION 0# PARTNERSHIP ❑# LLC 0# COMPANY NAME: STEPHEN A WINSLOW ADDRESS. 18 REARDON CIR, CITY S YARMOUTH STATE MA ZIP 026641207 TEL FAX ( I CELL I I EMAIL inspectionsgefwinslow.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE:$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY yarmouth MA DATE 05/17/21 PERMIT # L O G --2( ` (063L JOBSITE ADDRESS 4 westwoods, yarmouth port OWNER'S NAME ; Jefferson OWNER ADDRESS 7 TEL 508.362.2653 FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL CLEARLY NEW: RENOVATION: REPLACEMENT: v PLANS SUBMITTED: YES NO '',. APPLIANCES -1 FLOORS—k BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR RACE r inM A r'r rUr GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT j TEST _UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 1 OTHER wlo 551256 $40.00 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES Li NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND (7,73 OWNER'S INSURANCE WAIVER: I am awaie that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER lj AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurat to the b st of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complianc _ i a P rtine provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME t STEPHEN WINSLOW LICENSE # 12298 SIGNATURE MP v MGF JP JGF LPG! D CORPORATION # 3281C PARTNERSHIP # LLC # -. COMPANY NAME:[E.F. WINSLOW PLUMBING & HEATING ADDRESS 8 REARDON CIRCLE CITY ! SOUTH YARMOUTH STATE ' MA ZIP 02664 'TEL 508-394-7778 FAX 508-394-8256 CELL N/A JEMAILINSPECTIONS@EFWINSLOW CaM I